A Daughter’s Recollection

Janet G. Travell, MD A Daughter’s Recollection

by Virginia P. Wilson, now Virginia P. Street

Janet G. Travell, my mother, was born on 17 December 1901, in her parents’ home in a fashionable section of lower New York City. She decided to study medicine at an early age; in this she was inspired by her father, Willard Travell, MD, who was at first a general practitioner. Willard Travell soon became interested in the relief of pain through physical medicine and x-ray therapy, fields in which he is recognized as an early pioneer.1 Janet Travell’s mother, Janet Davidson Travell, was beautiful and talented. She played the piano, sang lullabies to her 2 daughters, and entertained artists, writers, and musicians in her eveningsat-home. My mother’s older sister, Ginny, also studied medicine. She became Virginia T. Weeks, MD, a respected pediatrician who practiced most of her life in
Brooklyn Heights.

My mother was nicknamed “Bobby” because her sister couldn’t say “baby.” She was a tomboy who climbed trees and hit tennis balls against a fence in the back yard at 27 East 11th Street. The back yard was home to a great-horned hoot owl, a partridge, an eel, baby chickens, and a snapping turtle. These were animals that the Travells had brought back to Manhattan from their summer home, 120 acres of farmland with an old Colonial house and outbuildings in the Berkshire hills of Massachusetts (Fig. 1). The summer home remains in the family to this day.

After graduating from the Brearley School, my mother attended Wellesley College,
the alma mater of her mother and sister, where she majored in inorganic chemistry. In her junior year, she was elected to the Phi Beta Kappa society and, at her graduation in 1922, she was named a Durant Scholar. She was also the winner of several college singles tennis championships and of many doubles titles with Ginny. In 1926, she received her MD degree from the Cornell University Medical College in New York City, where she graduated at the head of her class. That summer and fall, Janet took an extensive tour of Europe “to attain some perspective” on herself. (1) Then, from January 1927 through December 1928, she interned at the Cornell Medical Division of the New York Hospital, where she was “the only woman doctor on its staff.” (2)

Fig. 1 Janet’s sister, Virginia, and their father, Willard Travell, admire the tall hollyhocks at the family’s Merryfield Farm, Sheffield, Massachusetts, in the summer of 1936. (Photo courtesy of the author)

The Travells moved from 11th Street to 40 Fifth Avenue, and then on to 9 West 16th Street, a 5-story brownstone situated conveniently catty-corner across from the old New York Hospital, where my mother was house physician for the last 6 months of her internship. My grandmother, Janet Davidson Travell, supervised the remodeling of the family’s new home. The front stoop was removed and an elevator was added shortly before my grandmother died of a myocardial infarction in the fall of 1928. My parents were married less than a year later, in June 1929.

Bobby Travell had been introduced to her future husband—the dashing John
W.G. “Jack” Powell, a Southern gentleman, Wall Street banker, and talented college
athlete—at a white-tie ball in February 1927 at the Hotel Astor. She wrote in
her autobiography, Office Hours: Day and Night, published in 1968, that they “fell
in love on the dance floor that night” and have “danced through life together ever
since” (Fig. 2). (1) After their wedding, Jack Powell moved into 9 West 16th Street
with his wife and widowed father-in-law. Willard Travell began to practice medicine
in a suite of offices on the ground floor, and my mother soon joined him.

My mother had planned to be a cardiologist. On 1 January 1929, she became “a Fellow on a collaborative clinical research project to attempt to answer the controversial question: What value has digitalis in the treatment of lobar pneumonia?” The study, which was conducted by 3 university medical services (Cornell, New York University, and Columbia) on wards at Bellevue Hospital, combined Janet’s “basic interests in pharmacology and cardiology—in science and people.” (1) A year and a half later, in recognition of the importance of this research, she was awarded an instructorship at the Cornell University Medical College, where she remained for 30 years, achieving the rank of associate professor of pharmacology in 1952. (2)

After my sister Janet and I were born in 1933 and 1935, respectively, we lived at 9 West 16th Street for about 10 years (Fig. 3). We attended the Friends Seminary nearby. I remember how the waiting room on the ground floor next to the family medical offices was always filled with patients who told me how wonderful my grandfather and mother were to take away their pain.

From 1936 to 1945, my mother “served as assistant, then associate, visiting cardiologist at Sea View Hospital in Staten Island, and, under a fellowship grant from the Josiah Macy, Jr. Foundation, she studied arterial disease at Beth Israel Hospital in New York City
from 1939 to 1941. There she became absorbed in the study of new pain-relieving techniques.” (2) Later, she joined the staff of the hospital “and, at the time of her White House appointment, was an associatephysician in Beth Israel’s cardiovascular research unit. . . . After working as a cardiologist, with particular emphasis upon chest pain, she moved into the field of orthopedic medicine, where she specialized in the relief of musculoskeletal pain.” (2)

Fig. 2 Jack and Janet Powell with their pets, at the Paul M. Warburg estate in Hartsdale, New York, October, 1937. Betsy Warburg was Janet’s closest childhood friend. (Photo courtesy of the author)

My mother wrote in her autobiography that “the Cardiac Consultation Service at Sea View, the city hospital for tuberculosis on Staten Island to which I was appointed in 1936, supplied the conditions that crystallized my emerging interest in muscular pain. Most patients there had life-threatening pulmonary disease, but some of them complained more about devastating pain in their shoulders and arms than about their major illness. When I examined them by systematic palpation of the scapula and chest muscles, I easily uncovered the presence of trigger areas.” (1) It was during this time that Janet came across an article in the British Medical Journal titled, “A Preliminary Account of Referred Pains Arising from Muscle,” (3 which strongly influenced her thinking.

Unknown to Janet Travell, she was 1 of 3 clinicians—the others were Michael Gutstein (later known as Gutstein-Good and then as Good) (4) in Germany and Michael Kelly (5) in Australia—working “on three separate continents [who] simultaneously and independently published a series of papers in English” (6) about myofascial pain. They all emphasized “four cardinal features [of the condition]: a palpable nodular or band-like hardness in the muscle, a highly localized spot of extreme tenderness in the band, reproduction of the patient’s distant pain complaint by digital pressure on that spot [referred pain], and relief of the pain by massage or injection of the tender spot. Each author reported pain syndromes of specific muscles throughout the body in large numbers of patients. All three had identified myofascial TrPs [trigger points]. However, each had used different diagnostic terms” (6) and was apparently unaware of the others: “the commonality of their observations passed unnoticed for decades. . . . Of those three pioneers, only Travell’s influence withstood the test of time.” (6)

When my mother began the practice of medicine from her father’s offices around 1935, she was able to observe him with his patients. In the 1920s, Willard Travell had acquired a “Toepler-Holtz static machine that was employed then to treat painful conditions of
the muscles, nerves, and joints.” (1) In 1941, father and daughter wrote a scientific paper together, “Modifications and Effects of the Static Surge of the Static Wire-Brush Discharge.” (7) Willard Travell’s unique methods of relieving pain became the impetus behind my mother’s search for effective clinical methods to treat and manage the myofascial pain syndrome. A few years later, my grandfather “dismantled his static machines when newer methods of treatment became preferable.” (1)

When my mother herself began to suffer from shoulder and arm pain, my grandfather used the new procedure that his daughter had been exploring— injection into muscles—to rid her of her own pain. (1) In 1942, Janet Travell, Seymour H. Rinzler, and Myron Herman published “Pain and Disability of the Shoulder and Arm: Treatment by Intramuscular Infiltration with Procaine Hydrochloride.” (8) Ten years later, she and Rinzler “reported the pain patterns of TrPs in 32 skeletal muscles, as ‘The Myofascial Genesis of Pain,’ (9) which quickly became the classic source of this information.” (6)

Fig. 3 The Powell family on the Atlantic City boardwalk, April 1945. The girls are (left to right) Janet and Virginia. (Photo courtesy of the author)

In August 1944, my parents, my sister, and I moved from Manhattan to the small commuter town of Pelham, New York. My grandfather had married again.
His 2nd wife was a widow and close family friend, Edith Talcott Bates. ( Janet Travell’s stepbrother was then Talcott Bates, MD, who published 2 papers on myofascial pain. (10,11) The 2 Drs. Travell continued to practice medicine at 9 West 16th Street.

I first met Senator John F. Kennedy in front of 9 West 16th Street in the summer of 1955 or 1956. My husband and I had arrived there by car just as Kennedy finished a medical treatment with my mother and they walked outside together. In her autobiography, Janet described how the senator, who was on crutches when he first came to see her as a patient in May 1955, could barely navigate the 3 or 4 steps down from the curb to the front door, below street level. By the time that I met him, he was no longer on crutches. After we had
chatted for a minute or two (he always asked when we were going to our summer home “in western Massachusetts”), Senator Kennedy stepped forward and signaled to his driver to pick him up. I still remember how he looked, a thin man with an intense, friendly, and energetic manner and thick brown hair.

Senator Kennedy received so much relief of pain from my mother’s medical treatments that he had “new hope for a life free from crutches if not from backache,” wrote his friend and Special Counsel, Ted Sorensen, in his book, Kennedy. (12) The senator told my
mother that he was not going to change doctors. (1) She became the first woman ever to hold the post of White House physician “and the first civilian to do so since the administration of Warren G. Harding. . . . Kennedy described her as ‘a medical genius.’” (2) To show his appreciation for her efforts on his behalf, Kennedy gave her a framed color photograph of himself which hung in my mother’s White House Office during her years there. At the bottom of the picture, the President had written in his scrawling hand, “For Dr. Travell—Who made the smile possible—With affectionate regards, John Kennedy.”

My parents moved to Washington, DC, in January 1961, and 9 West 16th Street was sold. Willard Travell had been placed in a nursing home near Pelham when he suffered a stroke in 1959. Although he could no longer walk, he and my mother communicated by letter and telephone regularly. He died in August 1961 at the age of 91, 2 months after she had traveled with President Kennedy and his entourage to Paris and Vienna.

My grandfather was immensely proud of my mother for her achievements, and he in turn was her idol and mentor. She admired “his long lifetime of highquality performance in his profession.” She recalled his diseases whenever she heard people casually discussing “the health of our presidents.” (1) Her father had survived 3 myocardial infarctions. “He was not disabled by having had severe typhoid fever, diphtheria, scarlet fever, and poliomyelitis with partial paralysis of eye muscles that later required corrective surgery; by Paget’s disease of the spine and pelvis, fortunately arrested before it progressed to the bones of the skull; radiation burns of his hands, acquired in his pioneering application of x-rays; Type III lobar pneumonia; . . . diabetes and occlusive arteriosclerosis so advanced that pulses were absent in his feet. In his eighties, the only disability that really troubled him was ‘seeing double’ sometimes” when he hit a tennis ball. (1)

After President Kennedy’s assassination in 1963, his successor, President Lyndon B. Johnson, asked my mother to stay on in the White House as his physician. A year and a half later, she resigned to return to private practice and to write her autobiography. At the occasion of her farewell party on 25 March 1965, the Johnsons gave her a small framed document that said, “Prescription for Happiness” from “Drs. Johnson & Johnson & Johnson & Johnson, 1600 Pennsylvania Avenue, N.W., Washington, D.C., Office Hours Day & Night, BAckache 0-0000. 1 large dose of Dr. Janet Travell. Take frequently. A sure cure for aches, pains, occupational hazards, and general complaints on and off whistle-stops, in the White House and out. Lyndon B. Johnson and Lady Bird Johnson.” My mother borrowed a line from their thoughtful gift to use as the title of her autobiography.

Dr. Travell enjoyed her White House years to the fullest, but her real love was teaching, lecturing, and writing about the problems of stubborn, chronic myofascial pain. The 2-volume textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, coauthored by my mother and Dr. David G. Simons, notes that except for her years at the White House, “she has never strayed from her primary focus on the diagnosis and management of myofascial pain syndromes due to trigger points.” (13)

My mother met Dave Simons when she lectured at the School of Aerospace Medicine at Brooks Air Force Base in Texas in the 1960s. “David Simons became an avid exponent of the Travell concepts, and performed a yeoman task in surveying the international literature and in supplying the much needed neurophysiological verifications in the clinic and in the laboratory.” (13) He “wanted to document Travell’s work. He worked with her to write the trigger point manuals and tried to find scientific explanations for the success she was seeing from her treatments.” (14)

A succinct summation of my mother’s lifetime contribution appears in Clair Davies’ recent book, The Trigger Point Therapy Workbook. “Among those who recognize the reality and importance of myofascial pain,” he wrote, “Janet Travell is generally recognized as the leading pioneer in diagnosis and treatment. Few would deny that she single-handedly created this branch of medicine. . . . Her revolutionary concepts about pain have improved the lives of millions of people.” (15)

My sister, Janet, graduated from Wellesley College and I from Cornell University. We gave our mother 6 grandchildren. Janet moved to Italy and had a career as an opera singer. I was a sculptor and fine artist for many years, and lived in Nashville, Tennessee. After my father’s death from pancreatic cancer in July 1973, my mother took nonpaying borders into her Cathedral Avenue home. The young men and women prepared her meals, kept her company, and drove her to and from the airport. She continued to practice medicine, to lecture, and to write, even into her 90s. In 1994, I went to live with her, replacing her caregivers and her faithful secretary, and we finally had time for ourselves. We talked a lot and became close friends. In 1996, we moved to Northampton, Massachusetts, so that she could be nearer her family and also her beloved summer place. On 1 August 1997, she succumbed to congestive heart failure at home. She and my father are buried in the Davidson family plot in a cemetery in Albany, New York, not far from where Willard Travell grew up in Troy.